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The Shrewsbury and Telford Hospital NHS Trust
Patient LFT Reporting Form
Jemima Hughes
2023-05-24T14:05:46+01:00
Patient LFT Reporting Form
Last updated: 24 May 2023 at 14:05
Patients Information
Name
*
Patients First Name
Surname
Patients Date of Birth
*
DD slash MM slash YYYY
Test Information
Unit Number (Hospital Number from SemaHelix)
*
Lot Number of Test
*
Tested Person Type
*
Hospital Inpatient
Hospital Outpatient
Hospital ED
Reason for Testing
*
Outbreak on IPC advice
Symptomatic. Covid result will affect clinical management (Doctor request)
Discharge to care or nursing home
Admission or transfer to Adult oncology inpatient ward (S23)
Other
If none of these apply, does the patient need to be tested?
If 'Other' was selected on the above, please provide more details here:
Date Test was Taken
*
DD slash MM slash YYYY
Time Test was Taken (please use 24-hour format)
*
:
Hours
Minutes
Test Result (Please see the testing guide for details of how to interpret results shown on the device.)
*
Positive
Negative
Invalid
Patient Informed?
*
Yes
No
Test Taken By:
*
First Name
Last Name
Job Role/Title:
*
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